Master the board step 3

Hematology
Microcytic Anemia
Diagnostic Testing and Treatment
Specific Diagnostic Tests and Treatments
When this is in
the history/
physical…
Blood loss
Elevated platelet
count
Rheumatoid arthritis
End-stage renal
disease or
Any chronic
infectious,
inflammatory, or
connective tissue
disease
Very small MCV
with few or no
symptoms
Target cells
Alcoholic
Isoniazid
Lead exposure
…this is the
diagnosis.
Iron deficiency
Anemia of chronic
disease
Thalassemia
Sideroblastic anemia
What is the best
initial diagnostic
test?
Iron studies:
• Low ferritin
• High TIBC
Iron studies:
• High ferritin
• Low TIBC
Iron studies:
• Normal
Iron studies:
• High Fe
• Low Fe
• Low Fe
• Low Fe sat
• Elevated RDW
• Normal or low
Fe sat
What is the
most accurate
diagnostic test?
Bone marrow biopsy
(do not do this on
CCS)
No specific
diagnostic test
Hemoglobin
Electrophoresis
Beta: Elevated
HgA2,HgF
Prussian blue stain
Alpha: Normal
What is the best
initial therapy?
Prescribe ferrous
sulfate orally
Correct the
underlying disease
No treatment
for trait
Major: Remove the
toxin exposure
Minor: Prescribe
pyridoxine
replacement
A 62-year-old-man with a history of anemia from a bleeding peptic ulcer comes
for evaluation. He is constipated and has black stool. His medications are omeprazole,
oral ferrous sulfate, and occasional liquid antacids. What would you do next?
a. EGD
b. Colonoscopy
c. Guaiac testing/hemoccult
d. Discontinue omeprazole
e. Increase the dose of ferrous sulfate
Alpha thalassemia is most
accurately diagnosed by
DNA sequencing.
Answer: C. Oral ferrous sulfate can turn the stool black, but elemental iron such as this
does not make the stool guaiac positive. Only the iron in hemoglobin or myoglobin can
make the stool guaiac card positive.
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